Your baby's teeth

What's Baby Bottle Tooth Decay?

Baby bottle tooth decay is caused by the frequent and long-term exposure of a child's teeth to liquids containing sugars. Among these liquids are milk, formula, fruit juice, soft drink, and other sweetened drinks. The sugars in these liquids pool around the infant's teeth and gums, feeding the bacteria that cause plaque. Every time a child consumes a sugary liquid, acid attacks the teeth and gums. After numerous attacks, tooth decay can begin.

The condition also is associated with breast-fed infants who have prolonged feeding habits or with children whose pacifiers are frequently dipped in honey, sugar or syrup. The sweet fluids left in the mouth increases the chances of cavities while the infant is sleeping.

Below is a diagram that shows when your baby's teeth should come in:

How can I prevent baby bottle tooth decay?

Never allow children to fall asleep with a bottle containing milk, formula, juice or other sweetened liquids. Clean and massage the baby's gums to help establish healthy teeth and to aid in teething. Wrap a moistened gauze square or washcloth around the finger and gently massage the gums and gingival tissues. This should be done once a day.

Plaque removal activities should begin upon eruption of the first baby tooth. When brushing a child's teeth, use a soft toothbrush and a pea-shaped amount of fluoride toothpaste. Parents should first bring their child to the dentist when the child is between six and 12 months old.

Will changes in my child's diet help prevent baby bottle tooth decay?

Preventing baby bottle tooth decay involves changes in a child's diet. A series of small changes over a period of time is usually easier, and eventually leads to better oral health.

To incorporate these changes:

• Gradually dilute the bottle contents with water over a period of 2-3 weeks.
  Once that period is over, if you give a child a bottle, fill it with water or give the child a clean pacifier recommended by a dentist. The only safe liquid to put in a bottle to prevent baby bottle tooth decay is water.
• Decrease consumption of sugar, especially between meals.
• Children should be weaned from the bottle as soon as they can drink from a cup, but the bottle should not be taken away too soon, since the sucking motion aids in the development of facial muscles, as well as the tongue.

Why should I be worried about baby bottle tooth decay?

Giving an infant a sugary drink at nap or nighttime is harmful because during sleep, the flow of saliva decreases, allowing the sugary liquids to linger on the child's teeth for an extended period of time. If left untreated, pain and infection can result. Severely decayed teeth may need to be extracted. If teeth are infected or lost too early due to baby bottle tooth decay, your child may develop poor eating habits, speech problems, crooked teeth, and damaged adult teeth. Healthy baby teeth will usually result in healthy permanent teeth.

See a Baby tooth? See a Dentist!

Baby teeth are worth more than a just dollar under the pillow. Providing proper care and oral hygiene during a child's first year of life can mean a lifetime of good oral health, according to a recent article in AGD Impact, news magazine of the Academy of General Dentistry, an organization of general dentists dedicated to continuing education.

Traditionally, parents have waited to bring their children to the dentist until primary teeth begin to appear. A recent consumer poll by the American Academy of Pediatric Dentistry shows that nearly 70 percent of parents wait until their children are 3 years old before taking them to the dentist. But a dental visit by age 1-or within six months of the eruption of the first baby tooth-is crucial, says Academy spokesperson Cynthia E. Sherwood, DDS.

Dr. Sherwood says this early visit gives a dentist the opportunity to see potential problems such as early-childhood caries (also known as baby bottle tooth decay); educate the parent on proper oral hygiene for the child; and give the toddler a positive experience in a dental setting. This can do wonders in allaying fears and boosting the child's future attitude toward visiting the dentist, Dr. Sherwood says.

Education is the heart of the age 1 exam. "When we see a toddler, we primarily talk to the parents about growth, development, thumb sucking, bottle and breast feeding, oral hygiene and nutritional issues, use of fluoride and why baby teeth are important," Dr. Sherwood said.

During this first visit, the dentist usually will sit knee to knee with the parent, with the child nestled in the parent's lap, and the dentist will ask the parent to demonstrate how she or he brushes the child's teeth. Then, if parent and tot are comfortable, the dentist will turn the child around onto his or her lap, so the dentist can get a good look at the child's teeth and gums. This "pleasant, painless visit" should take no more than 15 minutes, Dr. Sherwood said.

"Sitting knee to knee with the parent, playing with the baby and talking with the parent, I can get a very good sense of the child's oral health care, and this position gives us a good opportunity to get a good look at the child's teeth," says Dr. Sherwood. "It's a great experience for everyone involved." Toddler dos and don'ts

Following a few simple rules can help ensure your children a good start in oral health.

DO:

• Take your child to the dentist within six months of the eruption of the first baby tooth, definitely by age 1.
• Follow your dentist's advice regarding nutrition, hygiene routine, fluoride and dental visit schedule.
• Teach your child how to brush around age 3, and brush your teeth with your children to model good technique and spot problems.

DON'T:

• Think baby teeth don't matter "because they'll just fall out anyway."
• Allow children to have continual access to a bottle or "sippy-cup" filled with anything other than water.
• Give your children the impression that visiting the dentist is unpleasant

Early Childhood Tooth Decay-Is Your Child At Risk?

The average healthy adult visits the dentist twice a year. The average healthy two-year-old has never been to the dentist. By kindergarten, twenty-five percent of children have never seen a dentist, yet according to the Surgeon General's Oral Health Report 2000, dental decay is the single most common chronic childhood disease in America.

The culprit? A combination of misinformation about when a child should first visit the dentist, when a parent should start caring for a child's teeth and the frequent and long-term exposure of sugary liquids to a child's teeth.

The Academy of General Dentistry recommends a child first visit the dentist six months after the eruption of the first tooth. During this first exam, the dentist can teach parents the best way to guard against early childhood tooth decay by wiping down the teeth with a damp cloth once a day and remind parents to limit sugary beverages.

Frequent and long-term exposure of a child's teeth to sugary liquids is commonly called baby bottle tooth decay. Most parents and dentists are aware of baby bottle tooth decay however, may not know that the long-term and regular consumption of sugary liquids in a bottle or cup puts children's growing teeth at increased risk for decay.

"Unsweetened fruit juices, teas and water are always best for children to help promote oral and overall health," says Cindi Sherwood, DDS, spokesperson for the Academy of General Dentistry, an organization of general dentists dedicated to continuing dental education.

According to the American Academy of Pediatrics, fruit juice causes tooth decay if children are allowed to hold a bottle, cup or box of juice in their mouth through the day.

"If left untreated, baby bottle tooth decay can result in pain and infection," says Dr. Sherwood. "Baby teeth are important because they hold the place for permanent teeth and help guide them into correct position. Severely decayed teeth may need to be extracted which could effect the development of permanent teeth, a child's speech and chewing."

Caring for children's teeth beginning in infancy promotes good oral health care habits for a lifetime and increases the chances of a child maintaining healthy permanent teeth.

Tips for Parents to Decrease the Risk of Early Childhood Tooth Decay

• Wean a child from the bottle or breast by age one.
• Use spill-proof cups as a transitional step in the development of children, not a long-term solution.
• Don't allow children to use spill-proof cups throughout the day. Save spill-proof cups for snack and mealtimes when increased salivary activity helps clean teeth.
• Drink sugary beverages through a straw. The best spill-proof cups to protect against decay are those with collapsible rubber straws.
• Introduce oral health care habits early. Wipe children's teeth with a damp cloth once a day. Introduce brushing with a soft-bristle brush and fluoridated toothpaste by age two under the supervision of a parent.

Sick of Your Baby's Ear Infections? Try Removing the Pacifier

If you've been running back and forth to the pediatrician's office because of your baby's ear infections, you may find some relief in a new study that just found an association between pacifier (dummy) use and acute middle ear infections, reports the Academy of General Dentistry, an organization of general dentists dedicated to continuing education.

Investigators studied 200 children who were 12 months of age or younger. They found that 36 percent of the pacifier users had ear infections, compared with 23 percent of the non-pacifier users.

Otitis media, the scientific term for acute middle ear infections, often develops when viruses from an infection of the nose and throat travel along the eustachian, or auditory, tube to the middle ear. It's a common problem, one that affects up to 62 percent of children by the time they reach their first birthday.

"Continuous sucking on a pacifier can cause the auditory tubes to become abnormally open, which allows secretions from the throat to seep into the middle ear," explains Maria Smith, DDS, spokesperson for the Academy of General Dentistry. "Transmission of bacteria in secretions would lead to middle ear infections."

Getting the baby to drop the pacifier, however, may not be so easy. Pacifiers date back to at least the 15th century, when mothers found that the sucking device helped quiet their crying babies. Since then, it has been confirmed that sucking is part of fetal and neonatal child development. Even after the baby is born, the baby has a strong, instinctual urge to suck for the first six months of life. After that period, according to researchers, the use of the pacifier is habit-forming.

"It may be best to consider restricting the pacifier to be used only for the baby's first 10 months," says Dr. Smith. "The pacifier comes in contact with many microorganisms and may be a vehicle through which the unsanitary bacteria and viruses enter the child's oral cavity."

The bottom line is that if your child is continuously battling middle ear infections, you may have an alternative to surgery or antibiotics to stop this problem, says Dr. Smith, which would be to remove the pacifier.

Watch For "Preemie" Teeth

Even though they do not have any teeth yet, prematurely born babies can expect to have dental complications as they grow older, reports the Academy of General Dentistry, an organization of general dentists dedicated to continuing dental education.

About six percent of babies are born before their due date and below 7.2 pounds, and of these, up to 70 percent will have enamel hypoplasia when their teeth erupt, according to a recent dental study. Enamel hypoplasia will cause teeth to look brownish, be softer, less smooth, or more prone to decay or chipping.

"You won't discover this until your child is about six months old because that's about the time when the baby's first tooth would erupt," says Henry Finger, DDS, FAGD, past president and spokesperson of the Academy of General Dentistry. "Prematurely born children should definitely see a dentist when their first tooth erupts to avoid any dental complications."

Children with the lowest birthweight and shortest gestational ages have the lowest rates of dental development, particularly before six years of age, according to the study. Children who were born prematurely can have delays in the eruption of their baby teeth and even their permanent teeth. When the teeth do erupt, they can look stained and brownish.

The front teeth are the first to erupt at six to eight months, and the back teeth erupt between 18 and 24 months. Prematurely born children should be brought to the dentist regularly, even at this early stage, because they are more likely to be candidates for cavities than children born at term.

Fluoride intake important after weaning

Parents should pay attention to the amount of fluoride a baby receives after weaning. Too much fluoride can cause tooth discoloration and too little fluoride can cause teeth to be more susceptible to cavities, according to the Academy of General Dentistry, an organization of general dentists dedicated to continuing education.

Bottled waters need to be on the list of items that parents must check before giving to their child. Some bottled waters have little or no fluoride at all.

"This is a problem when parents are giving their children only this 'designer' water from a bottle," says Heidi Hausauer, DDS, and spokesdentist for the Academy of General Dentistry. "In my own practice, I've seen an eight-year-old girl come in with eight cavities. The fact that she's been drinking only non-fluoridated water could have been a contributing factor. Most of the tap water in this country is properly fluoridated, so it's best if the child receives most of the water straight from the faucet."

When introducing toothpaste, the Academy of General Dentistry recommends using a small pea-sized dab.

"Parents should be brushing their children's teeth with this amount until the child is six years old," says Dr. Hausauer. "Until this age, children don't have the dexterity to brush by themselves properly and they tend to swallow the toothpaste and ingest the fluoride."